What are the indications for veneer placement?

Veneers are readily used to hide imperfections of teeth including fractures, staining and excessive discoloration. There are some cases of excessive spacing between the teeth that cannot be improved using orthodontic treatment, which can be fixed using veneers. Malpositioned teeth are another indication for veneers. Veneers are also used to give the teeth that have lost mineralized substance due to wear an artificial and ideal length. Gingival recession also gives way to the appearance of unsightly spaces between the teeth which can also be covered and concealed using veneers.

To summarize all indications, veneers are used to conceal malalignment, malpositioning, gingival recession, tooth wear, non-uniform color, symmetry and shape, to make the teeth appear straight and to allow the patient to have an ideal smile.

What is the difference between porcelain and a composite veneer?

One of the most frequently asked questions regarding veneers, is regarding the choice of the ideal material for the fabrication of a veneer. There are several advantages and disadvantages of both, but the major difference lies in the fact that composite veneers can be placed either directly or indirectly. Indirect application refers to the fabrication of the veneer in a dental laboratory by a dental technician and then later placed on to the surface of the tooth with the help of cement. On the other hand, a porcelain veneer can only be placed on to the tooth by indirect method.

It is a common misconception that veneers can be easily cemented onto the teeth without any complications or pain involved in the procedure. The truth is that the placement of veneers is an invasive procedure that involves the initial preparation of the teeth upon which the veneers will be placed. The teeth are shaped to the ideal size and height after which the veneers are placed on their surface with the help of dental cement. It is indeed true that they can easily hide all imperfection, discoloration and staining that will otherwise require multiple visits to the dentist to improve but it is important to remember that the placement of veneers is one of the most expensive procedures practiced in cosmetic dentistry, and thus require a hefty investment for a perfect smile.

Many dentists that practice cosmetic dentistry admit that the use of veneers to give instant, pseudo alignment to teeth is dangerous. This is because the preparation of teeth for the placement of veneers can destroy up to 30% of the healthy tooth substance which is why the use of veneers in younger patients is discouraged.

Common dental problems range from tooth aches, dental abscesses to tooth loss.  Stained or discolored teeth, swollen gums (gingivitis), crooked or maligned teeth, bruxism (teeth grinding), sensitivity, cavities, TMJ problems, abscessed teeth and halitosis are all dental problems many people face. These problems are caused by the consumption of certain foods, often diseases and poor dental hygiene.

 Stained or Discolored Teeth

Stained or discolored teeth are caused by the consumption of red wine, coffee, tea and carbonated sodas. Other causes for stained or discolored are smoking or chewing tobacco, tetracycline staining during fetal life and fluorosis.

Swollen Gums (Gingivitis)

This is a result of poor oral hygiene, leading to excessive build of plaque, calculus and tartar which irritate the gums, causing gingivitis. This is characterized by tender, inflamed and easily bleeding gums.

Crooked or Misaligned Teeth

The teeth may become crooked or misaligned from the poor development patterns of the teeth, usually caused by early loss of milk teeth, or overcrowding i.e. when permanent teeth replace milk teeth. Another cause is excessive nail biting, tongue thrusting, thumb sucking and pacifiers during childhood, while genetics also play a part in crooked or misaligned teeth.

Bruxism (Grinding Teeth)

Bruxism is when one clenches or grinds their teeth. It’s usually caused by stress, an abnormal or ‘bad’ bite and/or missing or crooked teeth. Since the grinding mostly happens when one is asleep, most people aren’t aware that they have bruxism. A dull consistent headache or a sore TMJ are telltale signs of bruxism. It should be treated immediately because it could lead to many other dental problems such as TMJ disorder, tooth wear, cracked- tooth syndrome and others.

Sensitivity

Tooth sensitivity or dentine sensitivity is discomfort, which happens when teeth are affected by either hot, cold or sweet foods. The discomfort is caused when the dentine (the under laying layer beneath the enamel crown) of the tooth becomes exposed due to receding gum tissue around the roots of the tooth. Once this is stripped away the dentine tubules are exposed and become stimuli for cold or hot or sweet food to reach the nerves which cause the discomfort.

Cavities

Cavities or tooth decay is probably the most common dental problem Cavities are caused by bacteria present in the mouth, as the bacteria convert food in the mouth to acids. The bacteria, acid and food debris in the mouth form plaque, which adheres to tooth surfaces causing dental decay. The acid in the plaque causes the enamel in the teeth to dissolve, creating holes in the teeth (cavities).

TMJ Pain

The TMJ (Temporomandibular Joint) is the area directly in front of the ear where the lower jaw bone meets the skull. TMJ pain occurs due to teeth grinding, habitual biting of finger nails or constant chewing of gum, dental problems, misalignment of teeth and stress or trauma to the jaw i.e. where the jaw bones have been fractured. Symptoms of TMJ are headaches, hearing sounds like popping, grinding or crunching sounds, ear pain, dizziness and ringing of the ear.

Abscessed Teeth

Abscessed teeth occur when there is a collection of infected material or pus in the center of the tooth. It is usually caused by tooth decay, a broken or fractured tooth, cracks or openings in the tooth enamel which allow the bacteria to enter of the tooth and affect the dental pulp. The infection causes the tissues in the tooth to swell, called pulpitis, causing a severe toothache. Other symptoms include bad breath, bitter taste, swelling of the lymph nodes, fever and malaise. A painful swelling in the upper or lower jaw is a very serious symptom.

Halitosis

Halitosis or bad breath is caused by poor oral hygiene, but it may also be a sign of other health problems.  It is also caused by eating certain types of foods which have strong odors like garlic or onions. Bad breath is also a sign for other health problems such as gum disease, dry mouth, cavities, poorly fitting dental appliances or even a yeast infection of the mouth. Smoking and chewing tobacco is also a major cause of halitosis.

The gels used for teeth whitening must be used with much care, especially if they are being used without the supervision of a dental professional. The reason for this lies in the fact that the iningredients of whitening gels can be harmful to the oral tissues if not used with caution and following strict protocol. When gel is used under safe concentrations and strict adherence to instructions, it will not cause any harm to the teeth or their surrounding tissues.

The bleaching agents contained in whitening gels are namely Carbamide peroxide (10- 44%) and Hydrogen peroxide (3- 16%), which are the active ingredients that release oxygen. This oxygen then acts on the enamel surface by incorporating itself into the enamel structure, resulting in whiter teeth. The caution factor is to be careful about the gums, as they are composed of delicate tissue compared to teeth, and can be harmed by the bleaching agents if they are used for too long or in too high concentrations.

How to use Teeth Whitening Gel

The basic outline is applying the gel inside trays which fit comfortably around the teeth. The tray is meant to allow good proximity of the gel and teeth so the former may work better. The tray is then placed in the mouth over the teeth containing the gel and is left in for the required amount of time for the bleach to work.

Brush and Floss prior to Treatment

One should brush and floss well before using the gel. Teeth whitening gel works best when teeth are clean and completely free from food debris and plaque. This allows better access of the bleaching agent to work on the tooth surface. Ensure that the bleaching tray is clean and dry, as moisture reduces the efficacy of the bleaching agents and also slows the whitening process.

Amount of Gel to Use

When applying the gel, make sure not to fill the trays with it, as it would then overflow and irritate the gums. Place small drops of the gel midway on the inner front surface of each tooth within the tray, and do not spread the gel. The purpose is to ensure that the gel only contacts the teeth well, not the gums. Each arch of the teeth will require approximately 0.5 ml of gel per use.

Placing the Tray

After the placing the tray in the mouth firmly over the teeth, wipe off any excess gel from the gums which may seep over the edges of the tray. This is to avoid irritating or harming the gums.

Treatment Duration

Recommended times for using whitening gels is 30 minutes to 1 hour for first time users.

Generally, gels containing Carbamide peroxide of 10- 16% may be used for 2- 4 hours, twice a day, and even overnight in case of no sensitivity. Those of 20- 22% concentration should not exceed 1 hour of wearing time per application, twice a day.

Hydrogen peroxide gels must not exceed 30 minutes to 1 hour per day.

Post Treatment

Rinse the mouth well and brush and floss as usual. Clean the tray with a tooth brush or a cotton swab. Any remaining gel should be completely cleaned off both, the teeth and tray.

After care

Store the whitening in the refrigerator, not a freezer. Keeping it in a cool place can prolong its shelf- life, even up to 2 years. Keep the trays out of heat and moisture, in a container or box.

If these instructions are strictly adhered to, the teeth whitening effect will be most prominent and you may enjoy your new bright white smile.

It is important to understand exactly what periodontal disease is, before discussing its signs and symptoms. Periodontal disease is a condition that involves gingiva (gums), the teeth, periodontal ligaments as well as the supporting alveolar bone. There are two conditions that are included in periodontal diseases, namely gingivitis and periodontitis.

What does periodontal disease result in?

Initial stages of gingivitis can be reversed using tooth cleaning procedures as well as the maintenance of good oral hygiene, however, the more advanced and progressed stages of gingivitis and periodontitis can result in tooth loss. The weakening of the periodontal ligament causes the loosening of the tooth in its socket and hence, eventual detachment from the alveolar bone. This initially results in tooth mobility and later, tooth loss. It is for this reason that it is critically important to prevent the development of periodontal disease, the progressed stages of which are irreversible and will ultimately result in tooth and bone loss.

What does tooth and bone loss by periodontal disease compromise?

The very first thing that comes to mind by tooth loss is difficulty in mastication, or chewing. If the periodontal disease is generalized in the mouth, it can cause mobility and weakening of all teeth which restricts the patient from consuming a daily diet. It may result in pain and difficulty when chewing. If the patient loses vital teeth that are involved in chewing, he will not be able to eat solid food which will eventually result in his overall weakness due to malnutrition. The second factor that is compromised by periodontal disease is esthetics. Once a patient start losing teeth, and cannot afford implants or dentures, it compromises the smile and makes it look unsightly. In the absence of vital teeth, the overlying tissues ‘dent inwards’ causing slight facial disfigurement as well. In advanced cases whereby multiple teeth have been lost as a result of periodontal disease, and the rest are mobile, the patient may even experience some degree of difficulty in speech and will eventually require a denture or other prosthesis.

What causes the development of periodontal disease?

There are many different factors that are involved in the development of periodontal disease, the most prominent of which is poor oral hygiene. The absence of a regular and effective teeth cleaning regime which involves brushing and flossing, can result in the accumulation of bacteria along the gingival margins of the teeth which later cause periodontal diseases.

What are the symptoms of periodontal disease?

Gingivitis is the inflammation of the gums, and it manifests as red and swollen gingiva, followed by bleeding gums which may worsen over time, bad breath which is also known as halitosis, gum recession due to the presence of plaque and calculus, and in the advanced stages, it can lead to tooth mobility and eventually tooth loss. An important point to note is the fact that bleeding of the gingiva is one of the very first indicators for the presence of periodontal diseases in most cases, which should alert patients to improve their oral hygiene.

Adults generally present with a type of periodontitis known as chronic periodontitis.  Progressed stages of periodontitis are irreversible and will ultimately cause tooth loss. Some of the symptoms of periodontitis include swollen, reddish or purplish gums, tenderness and bleeding on pressure, gum recession, recession of the inter-dental gingiva, foul breath and taste in the mouth and tooth mobility. These are the generalized symptoms of a progressed stage of periodontitis which will result in tooth loss.

The most effective way to prevent periodontal diseases is to maintain proper oral hygiene and in case of plaque and calculus accumulation, tooth cleaning and scaling must be considered.